[Simultaneous determination of 15 anti-obesity drugs in blood by high performance liquid chromatography-tandem mass spectrometry].

An analytical method for the simultaneous determination of 15 anti-obesity drugs (caffeine, sibutramine, phenformin, etc.) in blood sample was developed using high performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS). After a simple protein precipitation step, the HPLC separation was performed on an UltimateXB-C18 column with methanol and 20 mmol/L ammonium acetate (containing 0.1% (v/v) of glacial acetic acid) as the mobile phases in a gradient elution mode. The MS/MS detection was achieved by electrospray ionization in both positive and negative modes by rapid switching with selective reaction monitoring (SRM). The results showed that the limits of quantification of all anti-obesity drugs were in the range of 0.001 -0.05 mg/L. The calibration curves of all anti-obesity drugs showed good linearity and the correlation coefficients were more than 0.99. The recoveries of all antiobesity drugs at 3 spiked levels were in the range of 77.3% - 110.8% with the intra-day and inter-day precisions less than 12.3%. The mass spectrum characterizations of 15 anti-obesity drugs were studied. The method is sensitive and reproducible for the detection of the 15 anti-obesity drugs in blood, and can also be applied to the determination of the anti-obesity drugs in pharmaceuticals or foods.

Liver uptake of biguanides in rats.

Metformin is an oral antihyperglycaemic agent widely used in the management of non-insulin-dependent diabetes mellitus. The liver is the primary target, metformin being taken up into human and rat hepatocytes via an active transport mechanism. The present study was designed to compare hepatic uptake of two biguanides, metformin and phenformin, in vitro and in vivo. In in vitro experiments, performed using rat cryopreserved hepatocytes, phenformin exhibited a much higher affinity and transport than metformin, with marked differences in kinetics. The K(m) values for metformin and phenformin were 404 and 5.17µM, respectively, with CLint (V(max)/K(m)) values 1.58µl/min per 10(6) cells and 34.7µl/min per 10(6) cells. In in vivo experiments, when (14)C-metformin and (14)C-phenformin were given orally to male rats at a dose of 50mg/kg, the liver concentrations of radioactivity at 0.5 hour after dosing were 21.5µg eq./g with metformin but 147.1µg eq./g for phenformin, ratios of liver to plasma concentrations being 4.2 and 61.3, respectively. In conclusion, the results suggest that uptake of biguanides by rat hepatocytes is in line with the liver distribution found in vivo, phenformin being more efficiently taken up by liver than metformin after oral administration.

Solid phase extraction--non-aqueous capillary electrophoresis for determination of metformin, phenformin and glyburide in human plasma.

Solid phase extraction (SPE) was coupled at line to capillary electrophoresis (CE) for the determination of three basic and neutral diabetic drugs (metformin, phenformin and glyburide) in human plasma. The SPE procedure employed a C(18) cartridge to remove most of the water and proteins from the plasma sample. Analyte detectability was increased due to trace enrichment during the SPE process. Elution of metformin, phenformin and glyburide was achieved with methanol+3% acetic acid. CE analysis was performed using a non-aqueous buffer, acetonitrile+5mM ammonium acetate+5% acetic acid, which afforded rapid separation of metformin from phenformin within 3 min. Glyburide, with a migration time longer than 6 min, did not cause any interference. The present SPE-CE method, with an electrokinetic injection time of 6s and UV detection at 240 nm, was useful for monitoring down to 1 microg/mL of metformin and phenformin in human plasma. When the electrokinetic injection time was increased to 36s, the detection limits were improved to 12 ng/mL for metformin and 6 ng/mL for phenformin.

Biguanide-induced lactic acidosis.

Phenformin-induced lactic acidosis has been thought to be rare in India due to a high carbohydrate intake, use of suboptimal doses of phenformin and a lesser prevalence of alcoholism, as compared to Western countries. We studied the blood lactate levels of 31 non-insulin dependent diabetics (Group A) before and after treatment with phenformin, 75 mg/day for 4 weeks. Blood lactate rose significantly after treatment (mean +/- SEM 16.6 +/- 1.2 mg/dl to 30.7 +/- 2.2; p less than 0.01). Seven patients from this group had blood lactic acid level greater than 72 mg/dl. Six of these patients were restudied off treatment and after 4 weeks of phenformin therapy. The arterial blood pH, pCO2, pO2 and bicarbonate remained unchanged on treatment although a significant rise in blood lactic acid was reconfirmed in these 6 patients. Another group of 12 patients on phenformin for more than six months had significantly lower blood lactate levels as compared to group A (mean +/- SEM 20.2 +/- 1.8 mg/dl vs 30.7 +/- 2.2 mg/dl; p less than 0.01) indicating the possibility of a process of adaptation on prolonged treatment. This possibility was confirmed by a serial follow-up study of 11 patients for a 6 month period on phenformin therapy. A case of biguanide-induced lactic acidosis diagnosed and treated by us is described.

Plasma biguanide levels are correlated with metabolic effects in diabetic patients.

Metabolic abnormalities occur in biguanide-treated diabetic patients. We investigated the relationship between plasma metformin and phenformin concentrations and metabolic effects. Drug levels were measured in 37 type II diabetic patients by HPLC. The method was sensitive, specific, and linear over a wide range of drug concentrations. Metformin and phenformin values ranged from 236 to 718 ng/ml and from 28 to 114 ng/ml, respectively. The plasma metformin level was correlated with triglycerides (r = -0.55; P less than 0.05) but not with drug dosage, plasma glucose, HbA1, creatinine, creatinine clearance, lactate, pyruvate, lipid, and clinical parameters. Plasma phenformin concentrations correlated with lactate (r = 0.49; P less than 0.05) and HbA1 (r = 0.50; P less than 0.05) but not with drug dosage, parameters of diabetes control, creatinine, creatinine clearance, pyruvate, and clinical parameters. The clinical usefulness of this HPLC method, the evidence that the increase of lactate is related to the circulating phenformin levels, and the demonstration that the metformin effect on triglyceride metabolism is correlated to plasma drug levels are the positive findings of this work.

The effects of phenformin on the transport and metabolism of sugars by the rat small intestine.

The effects of 0.25-10 mM phenformin on sugar transport and metabolism have been studied in a preparation for the combined perfusion of the vascular bed and the lumen. At all concentrations the effects of vascular phenformin were more pronounced than those of luminal phenformin. Phenformin inhibited galactose transport across the intestine, the pattern of inhibition depending on whether the phenformin was added to the luminal or vascular compartments. The active accumulation of galactose in the mucosal epithelial cells was also abolished. There was a linear relationship between the percentage reduction in mucosal ATP levels and vascular phenformin concentration. Phenformin reduced the rate of glucose uptake from the lumen, and the proportion of this glucose which reached the vascular effluent. Most of the glucose which did not reach the vascular side could be accounted for by the formation of lactic acid. Vascular phenformin increased glucose uptake from the vascular medium by ca 88%, 97% of which could be accounted for by lactate formation. Phenformin was sequestered by the mucosa when added to the vascular, but not the luminal, perfusates. There was very little translocation of intact phenformin across the gut in either the mucosal or serosal directions. It is suggested that the effects of phenformin on the gut mainly derive from an inhibition of mitochondrial oxidative phosphorylation, with a small contribution from a direct effect on the brush border, more pronounced at high phenformin concentrations. The results are consistent with the idea that phenformin delays sugar absorption in man, and that the intestine may be a significant source of lactate production in lactic acidosis.

Defective hydroxylation of phenformin as a determinant of drug toxicity.

The kinetics of phenformin and its metabolite, p-hydroxyphenethylbiguanide, was studied in eight diabetic patients with varying degrees of renal impairment. Plasma and urinary phenformin and p-hydroxyphenethylbiguanide levels were determined by the multiple selected ion monitoring technique. Phenformin half-lives were unrelated to the degree of renal impairment, whereas reduced renal clearances of insulin and creatinine were significantly correlated with a prolonged half-life of the metabolite. The excretion of p-hydroxyphenethylbiguanide was quite variable (between 4.9% and 27% of total urinary drug loss), probably due to a genetic polymorphism of hepatic mechanisms for hydroxylation. A reduced formation of the metabolite was concomitant with marked increases in the amount of circulating phenformin. A positive reciprocal correlation was detected between areas under the plasma curve of phenformin and both the renal clearance of the unchanged drug and the percentage of metabolite formation. A reduced hydroxylation of phenformin seems, therefore, to be responsible for the high plasma levels of the drug previously described in toxic patients.

Correlation of plasma phenformin concentration with metabolic effects in normal subjects.

1. Circulating concentrations of intermediary metabolites have been measured after administration of 50 mg of phenformin to normal subjects. 2. Phenformin caused a significant increase in blood lactate, alanine and the lactate/pyruvate ratio but did not affect blood glucose or serum insulin concentrations. 3. There was a significant correlation between the increase in blood lactate concentration after phenformin and the plasma concentration of the drug.

Metabolism, plasma or serum levels, and elimination of phenformin in guinea pigs, rats, and dogs.

14C-Phenformin hydrochloride was used for investigating the metabolism, plasma or serum levels, and elimination of the drug following 1.5-mg/kg po or iv doses to guinea pigs, rats, and dogs. The amounts of individual metabolites and unchanged drug were assessed in urine as well as in plasma or serum. The glucuronide of 1-(p-hydroxyphenethyl)biguanide was a major metabolite in the blood and urine of all three species. Guinea pig serum and urine contained a sizable quantity of unchanged drug. Dog plasma and urine had significant amounts of nonconjugated 1-(p-hydroxyphenethyl)biguanide and of an unidentified major metabolite. In all three species following intravenous drug administration, unchanged drug contributed significantly to the radioactivity found in blood and urine. The apparent half-lives of phenformin eliminateion were 0.3-0.8 day for guinea pigs and rats and 1-1.5 days for dogs. Urinary excretion data indicate apparent half-lives of approximately 1.3-1.5 days for the elimination of each of the three major metabolites in dogs.

Determination of oral anti-diabetic agents in human body fluids using high-performance liquid chromatography.

Two widely prescribed anti-diabetic agents for which no simple assay method was previously available can now be determined by high-performance liquid chromatography using a UV detection system. The two drugs investigated were tolbutamide (a sulphonylurea) and phenformin (a biguanide). Tolbutamide can be assayed directly, after a single extraction step, on a reversed-phase system, illustrating the simplicity of the technique for carrying out analyses on underivatised drug compared with gas chromatography. Phenformin was not so easily chromatographhed using straightforward partition systems; however, by the choice of a suitable ion-pair agent it was possible to chromatograph the underivatised drug in a relatively simple reversed-phase system.

Hemodialysis for phenformin associated lactic acidosis.

A patient who attempted suicide by ingesting a large amount of phenformin developed a severe lactic acidosis. After receiving hemodialysis on two successive days, she recovered without sequela. On both occasions, the dialyses temporarily improved the degree of acidosis. The amount of phenformin extracted during these two procedures was measured and found to be only 1.5% of the total amount of drug ingested. Therefore, it is felt that hemodialysis does not remove the offending drug but does play a supportive role in the management of these patients by temporarily ameliorating some of the biochemical abnormalities.

Serum phenformin concentrations in patients with phenformin-associated lactic acidosis.

Phenformin concentrations were measured in serum from seven patients with phenformin-associated lactic acidosis, and initial values ranging from 20 to 625 ng./ml. were obtained. Five of the seven patients had serum concentrations within the usual therapeutic range of up to 241 ng./ml. Serum phenformin concentrations were measured serially, and apparent half-lives of 5, 25, and 30 hours were obtained in three patients with serum creatinine concentrations of 1.7, 7.6, and 6.0 mg./dl., respectively. Although the half-life of phenformin was prolonged in azotemic patients, no correlation between serum creatinine concentration and serum phenformin could be demonstrated; furthermore, the severity of lactic acidosis as measured by arterial pH and lactate concentration did not correlate with the serum creatinine concentration.

[Lactic acidosis after administration of guanidine derivatives (buformine, phenformine) (author's transl)]. / Lactatacidose und Biguanidtherapie

Three patients are reported on, who at the time of admittance showed a decompensated metabolic acidosis, elevated concentrations of serum lactate and a reduced kidney funktion. All the patients had taken guanidine derivates (phenformine, buformine) because of diabetes mellitus. The serum biguanid concentrations, however, were elevated in only two cases. Therapy of the lactic acidosis has to be directed at the underlying disease. In biguanid incluced acidosis, haemodialysis with simultaneous administration of sodium bicarbonate is indicated.

Characterization of phenformin and metabolites in plasma.

A colorimetric assay of biguanides was adapted for small volumes of plasma and its specificity was improved. This method is based on the reaction of guanidine groups with alpha-naphtol-diacetyl. Interference of endogenous guanidine derivatives and of the water-soluble metabolites of phenformin can be excluded by the extraction procedure. Counting of plasma fractions from 14C-phenformin-injected rats and thin-layer chromatography, before and after treatment with beta-glucuronidase, were also performed: the results suggest that after adequate extraction of plasma, the colorimetric assay measures specifically the biologically active phenformin. Results of this assay in plasma from biguanide-induced lactic acidotic patients and rats are given and compared with controls : results are consistent with the hypothesis of an accumulation of biologically active biguanide in such cases.

Gas chromatographic determination of beta-phenethylbiguanide and its metabolite p-hydroxy-beta-phenethylbiguanide in serum and urine.

A gas chromatographic method is presented for the detection of beta-phenethylbiguanide (PEBG) and its metabolite, p-hydroxy-beta-phenethylbiguanide (p-OHPEBG). The procedure is applicable for the determination of the drug and its metabolite in the serum and urine of rats. The detection limit is 0.2 mug PEBG and 0.5 mug p-OH PEBG per ml of serum or urine. A time course study of blood concentration and elimination rate following intraperitoneal injection of 100 mg/kg of PEBG to normal rats was performed. Beta-PEBG was found to be present in the blood and the urine, p-OH PEBG was only detected in the urine. Twenty-four hours following intraperitoneal injection, the urine contained 32% of the administered dose, 20% as unaltered PEBG and 12% as p-OH PEBG.